Cancer in the Elderly

“He’s too old to treat.”
I hear it all
the time. It’s a sign of age bias as well
as not being caught up on the major advances
in cancer treatment – including
treatment of older people.

First, who is old?
It’s not an easy
question, and certainly, there is no easy
answer. Some cancer research trials
define elderly as someone 65 and older,
as that’s when a person is eligible for
Medicare and for many people, Social
Security. But it is way off the mark
when you look at the data. A healthy
65 year old today will live an average
of 20 more years, a healthy 75 year old,
12 more years, and a healthy 85 year
old, 6 more years. Moreover, we have
compelling research data that show that
older people in good health usually
derive similar benefits from modern
cancer treatments – including surgery,
radiation therapy, and chemotherapy
– as younger people. For those with
breast and colon cancer that is found
early, older and younger people receive
similar benefits from adjuvant
chemotherapy (chemotherapy given
to prevent the spread of cancer).

Why should we care about older
people with cancer?
We need to care
because in the United States and other
developed countries, cancer is a disease
of aging. The average age of developing
cancer in the United States is in
the late sixties, and the incidence of
cancer increases dramatically with age.
Moreover, the U.S. population continues
to age. At present, about 12 percent of
Americans are 65 years and older while
in 2025, it is projected that 20 percent
of us will be in this older age group.
This will put a major strain on an already
fragile healthcare system as well
as Medicare funding. Considering the
present shortage of gerontologists and
the concern that there will also be a
dramatic shortage of oncology healthcare
professionals in the next 20 years,
we need to prepare now for caring for
elders with cancer. The Institute of
Medicine in its seminal 2008 report
“Retooling for an Aging America” has
clearly defined these issues as well as
potential remedies.

We have compelling research data that show that older
people in good health usually derive similar benefits from
modern cancer treatments as younger people.

Research on treating cancer in older
people has previously been sparse. In
the past, older people were excluded
from clinical trails based on their age
alone. Although age restrictions have
been eliminated from most clinical trials,
age bias remains, and older people
are poorly represented in most clinical
trials. This results in a lack of information
concerning the risks and benefits of
newer, better, more expensive, and potentially
more toxic treatments in older
people, making it harder for physicians
to make the best treatment decisions.

In addition, many older people with
cancer have other medical illnesses, and
sometimes these illnesses are more
serious and more likely to result in a
decreased life span than the cancer itself.
How best to manage cancer in the
elderly is frequently uncertain, and much
research is needed in this area, as well
as in managing cancer in frail people.

Unfortunately, most oncologists have
not had adequate training in geriatrics
to help in decision making for older
people with cancer. Currently, trials
are under way, testing tools that can be
rapidly completed and that provide a
comprehensive geriatric assessment that
evaluates functional status, other medical
conditions, cognition, nutritional
status, psychological state, social support,
and the person’s medications.
Integrating these tools into clinical
trials should provide us the needed information
on benefits and side effects
of new treatments in older people with
cancer. In addition, a small but growing
number of clinical trials designed
specifically for older people are now
in progress and will add to our reserve
of knowledge.

What should older people do
when faced with a cancer diagnosis?
First, they need to have a clear discussion
with their healthcare team
concerning the details of the diagnosis,
whether the cancer is curable or
not, what the treatment options are,
what the side effects and potential
costs are for each of the options, and
if there are any clinical trials they
might be eligible for. As cancer is a
disease that affects the entire family,
it is important that the older person
with cancer involve the family early
on and include
family members
in key
treatment
discussions.

Older people
should not
be afraid to
ask questions
and to insist
on clear explanations
concerning diagnosis and treatment.
Older people represent the majority
of Americans with cancer, but it
is crucial that they not remain a
“silent majority.”

♦ ♦ ♦ ♦ ♦

Dr. Hyman Muss is professor
of Medicine at the University of Vermont
and Vermont Cancer Center

This article was printed from copingmag.com and was originally published in Coping® with Cancer magazine,
January/February
2009.